Relationship between thickness of fibrosis and epithelial dysplasia in oral submucous fibrosis

Aim: Although oral submucous fibrosis is characterized by fibrosis of the subepithelial connective tissue, the overlying epithelial changes contribute to malignant transformation. Therefore, the aim of the study was to evaluate the relationship between thickness of fibrosis and epithelial changes in oral submucous fibrosis. Methods: The relationship between thickness of fibrosis and presence or absence of epithelial dysplasia was evaluated in 107 biopsies containing histo-pathologically-confirmed oral submucous fibrosis. The results were analyzed using Student's t-test or chi(2) -test. Results: Fifty-seven percent (61/107) of oral submucous fibrosis lesions showed a non-dysplastic overlying epithelium, while 43% (46/107) showed varying degrees of epithelial dysplasia. The mean thickness of fibrosis of non-dysplastic lesions was 0.91 +/- 0.41 mm (mean +/- standard deviation) and ranged from 0.25 to 1.9 mm. However, the mean thickness of fibrosis of dysplastic lesions was 1.17 +/- 0.52 mm and ranged from 0.48 to 3 mm. The results revealed a significant increase in the incidence of epithelial dysplasia as the thickness of fibrosis increased (P = 0.004). As such, the lesions that showed increased fibrosis were more likely to present with epithelial dysplasia. Conclusions: The advancement of fibrosis increases the risk of development of epithelial dysplasia in oral submucous fibrosis.